Early diagnosis of dengue disease severity in a resource-limited Asian country
Early diagnosis of dengue disease severity in a resource-limited Asian country
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DOI：
10.1186/s12879-016-1849-8
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发表时间：
2016-09-26
影响因子：
3.7
通讯作者：
Buchy, Philippe
中科院分区：
文献类型：
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作者：
Cavailler, Philippe;Tarantola, Arnaud;Buchy, Philippe
背景：登革热在柬埔寨全国流行，该国面临着重大的健康和经济挑战。我们在金边国家儿科医院进行了一项临床研究，以评估登革热的临床诊断参数和疾病结局的预测因素。方法：2011年9月至2013年1月期间，所有年龄在1至15岁之间且疑似登革热的连续住院患者均入选。使用1997年和2009年世卫组织登革热分类对它们进行了临床评估。标本收集入院和出院后，在巴斯德研究所在Cambodia.Results进行登革热检测：共701例患者进行了筛选。其中，79%经实验室检测证实为登革热，21%检测为登革热阴性。止血带试验阳性、无上呼吸道症状、白细胞减少症、血小板减少症和肝转氨酶升高是儿童实验室确诊登革热的独立预测因素。入院时几个警告信号的存在与并发实验室确诊的严重疾病outcome.Conclusions的诊断相关：两个或两个以上的警告信号的存在与并发实验室确诊的严重登革热入院。因此，结合简单临床参数和一线实验室结果的累积评分可用于准确预测儿科人群中的登革病毒感染，优化实验室资源有限的环境中的分诊。
Background: Dengue is endemic throughout Cambodia, a country faced with significant health and economic challenges. We undertook a clinical study at the National Paediatric Hospital in Phnom Penh to evaluate clinical diagnostic parameters for dengue and predictors of disease outcome.Methods: Between September 2011 and January 2013, all consecutive inpatients aged between 1 and 15 years and presenting with suspected dengue were enrolled. They were clinically assessed using both the 1997 and 2009 WHO dengue classifications. Specimens were collected upon admission and discharge and tested for dengue at Institut Pasteur in Cambodia.Results: A total of 701 patients were screened. Of these, 79 % were dengue-confirmed by laboratory testing, and 21 % tested dengue-negative. A positive tourniquet test, absence of upper respiratory symptoms, leukopenia, thrombocytopenia, and elevated liver transaminases were independent predictors for laboratory-confirmed dengue among the children. The presence of several warning signs on hospital admission was associated with a concurrent laboratory-confirmed diagnosis of severe disease outcome.Conclusions: The presence of two or more warning signs was associated with a concurrent laboratory-confirmed diagnosis of severe dengue at hospital admission. Thus, a cumulative score combining simple clinical parameters and first-line laboratory findings could be used to accurately predict dengue virus infection in pediatric populations, optimizing triage in settings with limited laboratory resources.